Federal Investments to Eliminate Racial/Ethnic Health-Care Disparities

Moy, Ernest; Freeman, William L.

doi:10.1177/00333549141291s212

Cited by 19 publications

(18 citation statements)

References 12 publications

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“…Despite decades of efforts to improve access to and quality of healthcare for those with limited English proficiency, patientprovider communication among those with LEP remains a concern for federal and state healthcare policy. 13,16 Little is known about how patient-provider communication changed or did not change following the historic healthcare reforms in 2010. Our results show that non-LEP individuals were steadily improving on three patient-provider communication measures.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Efforts to improve patient-provider communication have been ongoing for decades, as clinicians, researchers, and policymakers have made significant efforts to eliminate disparities. [10][11][12][13] Federal policy attempts at reducing disparities for LEP individuals began with the Civil Rights Act of 1965, which made it illegal to discriminate on the basis of foreignborn status. 14 This legislation prohibits discrimination based on national origin, thus providing equal protection for immigrants.…”

Section: Introductionmentioning

confidence: 99%

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Patient-Provider Communication Disparities by Limited English Proficiency (LEP): Trends from the US Medical Expenditure Panel Survey, 2006–2015

Berdahl

Kirby

2018

J GEN INTERN MED

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BACKGROUND: Individuals with limited English proficiency (LEP) have worse healthcare access and report lower quality of care compared to individuals who are proficient in English. Policy efforts to improve patientprovider communication for LEP individuals have been going on for decades but linguistic disparities persist. OBJECTIVE: To describe trends in patient-provider communication by limited English proficiency (LEP) from 2006 to 2015. DESIGN: We estimated interrupted time series models for three measures of patient-provider communication, testing for differences in both means (intercepts) and trends (slopes) before and after 2010 and differences in differences by English proficiency. PARTICIPANTS: A nationally representative sample of the US non-institutionalized population with at least one office-based medical visit from the 2006-2015 Medical Expenditure Panel Survey (N = 27,001). MAIN MEASURES: Patient-provider communication is measured with three variables indicating whether individuals reported that their providers always explained things in a way that was easy to understand, showed respect for what they had to say, and listened carefully. KEY RESULTS: Although patient-provider communication improved for all groups over the study period, before 2010, it was getting worse among LEP individuals and disparities in patient-provider communication were widening. After 2010, patient-provider communication improved for LEP individuals and language disparities by English proficiency either narrowed or remained the same. For example, between 2006 and 2010, the percent of LEP individuals reporting that their provider explained things clearly declined by, on average, 1.4 percentage points per year (p value = 0.102); after 2010, it increased by 3.0 percentage points per year (p value = 0.003). CONCLUSIONS: Our study sheds light on trends in patientprovider communication before and after 2010, a year that marked substantial efforts to reform the US healthcare system. Though patient-provider communication among LEP individuals has improved since 2010, linguistic disparities persist and constitute a formidable challenge to achieving healthcare equity, a long-standing US policy goal.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient-Provider Communication Disparities by Limited English Proficiency (LEP): Trends from the US Medical Expenditure Panel Survey, 2006–2015

Berdahl

Kirby

2018

J GEN INTERN MED

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“…Although precision medicine breakthroughs offer the potential to reduce disease burden and mortality, there is also the potential for them to widen existing racial and ethnic health disparities (Smith et al, ). Racial and ethnic health disparities in the US have been linked to unequal healthcare access and social determinants of health (SDH), such as discrimination, residential segregation, low education, poverty, and income inequality (Galea, Tracy, Hoggatt, Dimaggio, & Karpati, ; Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, ; ; ; Moy & Freeman, ). Consistent with the Diffusion of Innovation Theory (Rogers, ), which explains how, why, and at what pace new technologies or ideas are disseminated through a society, new medical innovations tend to be disseminated unevenly, benefiting socially advantaged groups more quickly than disadvantaged groups, such as racial and ethnic minorities.…”

Section: Introductionmentioning

confidence: 99%

Racial and ethnic differences in knowledge and attitudes about genetic testing in the US: Systematic review

Canedo

Miller

Myers

et al. 2019

Journal of Genetic Counseling

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Precision medicine has grown over the past 20 years with the availability of genetic tests and has changed the one‐size‐fits‐all paradigm in medicine. Precision medicine innovations, such as newly available genetic tests, could potentially widen racial and ethnic disparities if access to them is unequal and if interest to use them differs across groups. The objective of this systematic review was to synthesize existing evidence on racial and ethnic differences in knowledge of and attitudes toward genetic testing among adult patients and the general public in the US, focusing on research about the use of genetic testing in general, not disease‐specific tests. Twelve articles published in 1997–2017 met inclusion and exclusion criteria, with 10 including knowledge variables and seven including attitude variables. Studies found consistent patterns of lower awareness of genetic testing in general among non‐Whites compared to Whites, lower factual knowledge scores among Blacks and Hispanics/Latinos, and mixed findings of differences in awareness of direct‐to‐consumer (DTC) genetic testing or the term precision medicine. Blacks, Hispanics/Latinos, and non‐Whites generally had more concerns about genetic testing than Whites. The findings suggest that patients and the general public need access to culturally appropriate educational material about the use of genetic testing in precision medicine.

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“…Precision medicine (PM) is changing the one-size-fits-all healthcare paradigm for prevention and treatment of diseases through incorporation of an individual's genetic makeup, environment, and lifestyle [1,2]. At the same time, however, PM advances have the potential to widen racial and ethnic health disparities in the United States [3][4][5][6][7]. People of non-European ancestry are underrepresented in genetic databases, a sampling bias that can translate to clinical care bias and result in disparate outcomes or health disparities [8,9].…”

Section: Introductionmentioning

confidence: 99%

Factors influencing precision medicine knowledge and attitudes

Chakravarthy

Stallings²,

Williams

et al. 2020

PLoS ONE

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Precision medicine holds great promise for improving health and reducing health disparities that can be most fully realized by advancing diversity and inclusion in research participants. Without engaging underrepresented groups, precision medicine could not only fail to achieve its promise but also further exacerbate the health disparities already burdening the most vulnerable. Yet underrepresentation by people of non-European ancestry continues in precision medicine research and there are disparities across racial groups in the uptake of precision medicine applications and services. Studies have explored possible explanations for population differences in precision medicine participation, but full appreciation of the factors involved is still developing. To better inform the potential for addressing health disparities through PM, we assessed the relationship of precision medicine knowledge and trust in biomedical research with sociodemographic variables. Using a series of linear regression models applied to survey data collected in a diverse sample, we analyzed variation in both precision medicine knowledge and trust in biomedical research with socioeconomic factors as a way to understand the range of precision medicine knowledge (PMK) in a broadly representative group and its relationship to trust in research and demographic characteristics. Our results demonstrate that identifying as Black, while significantly PMK, explains only 1.5% of the PMK variance in unadjusted models and 7% of overall variance in models adjusted for meaningful covariates such as age, marital status, employment, and education. We also found a positive association between PMK and trust in biomedical research. These results indicate that race is a factor affecting PMK, even after accounting for differences in sociodemographic variables. Additional work is needed, however, to identify other factors contributing to variation in PMK as we work to increase diversity and inclusion in precision medicine applications.

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Federal Investments to Eliminate Racial/Ethnic Health-Care Disparities

Cited by 19 publications

References 12 publications

Patient-Provider Communication Disparities by Limited English Proficiency (LEP): Trends from the US Medical Expenditure Panel Survey, 2006–2015

Patient-Provider Communication Disparities by Limited English Proficiency (LEP): Trends from the US Medical Expenditure Panel Survey, 2006–2015

Racial and ethnic differences in knowledge and attitudes about genetic testing in the US: Systematic review

Factors influencing precision medicine knowledge and attitudes

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